Implementation and Evaluation of a Fall Risk Screening Strategy Among Frail Older Adults for the Primary Care Setting: A Study Protocol.

BACKGROUND: Falls are an increasing problem among older people. There are several evidence-based interventions available to prevent falls. However, these are not always well implemented in the primary care setting. General practitioners (GPs) are often the first point of contact for health issues, making them the designated professionals for providing falls prevention. Because GPs are often unaware which patients have a high fall risk and patients themselves do not always know they have a high fall risk, this study aims to evaluate the implementation of a targeted fall risk screening strategy among independently living, frail older people in the primary care setting. MATERIALS AND METHODS: The targeted fall risk screening strategy used in this study consists of tools for screening high fall risk and for identifying the underlying cause(s) of the high fall risk, an accredited training course in falls prevention for professionals, and service provision by certified physio- and exercise therapists who are able to offer evidence-based falls prevention interventions. This targeted fall risk screening strategy will be implemented in the primary care setting and evaluated at the level of the GP practice and at the level of the patient by using the RE-AIM model of Glasgow et al. In a pre-posttest design, data will be collected of the total number of frail older people who are screened, referred and enrolled for fall-preventive care. Furthermore, barriers and facilitators of the implementation of the fall risk screening strategy will be identified by conducting focus groups and interviews with the care providers and frail older patients. Additionally, the influence of the falls prevention interventions on frail older patients will be evaluated by using a pre-posttest design with a 12-month follow-up period during which data are collected regarding patients' stability, mobility, strength, balance, self-efficacy, health status, and daily activities. STUDY REGISTRATION: This study is approved by the Medical Ethics Committee Brabant, the Netherlands (NL61582.028.17/ P1732) and registered at the Netherlands Trial Register, NL7917.

Collaboration of general practitioners and exercise providers in promotion of physical activity a written survey among general practitioners.

BACKGROUND: General practitioners have an ideal position to motivate inactive patients to increase their physical activity. Most patients are able to exercise in regular local facilities outside the health care setting. The purpose of this study was to get insight into general practitioners perceptions and current practices regarding referral of patients to local exercise facilities. Furthermore, collaboration with exercise providers in the community was investigated, and motivators and barriers for referral. METHODS: A written questionnaire sent to a representative random sample of 800 Dutch general practitioners. Descriptive statistics and Chi(2) tests were used. RESULTS: All responding general practitioners (340) recommend their patients to take more exercise when necessary and 87 % say to refer patients sometimes. Limited motivation of the patient (44 %) and reduced health status (34 %) are the most mentioned barriers for advising patients to increase physical activity. When referred, most patients are send to a physical therapist (69 %) but also local exercise facilities were mentioned (54 %). The most important barrier for referring patients to local exercise activities are patients limited financial possibilities (46 %). Restricted knowledge of local exercise- or sport facilities was an additional barrier (19 %). There is little structural collaboration between general practitioners and exercise providers, but when collaboration exists general practitioners refer more often. Positive experiences of patients (67 %), affordable offers (59 %) and information of local exercise facilities (46 %) are seen as important promoting factors for referral. Although 32 % of the general practitioners think that good collaboration would be stimulating, regular meetings with sports and exercise providers were considered the least important for increasing referral (3 %). CONCLUSIONS: Dutch physicians have a positive attitude towards stimulating physical activity but referral to local exercise facilities is low. Referral is partly hindered by restricted knowledge of local exercise facilities. Although general practitioners think that collaboration is important for physical activity promotion, it should not cost them much extra time. A coordinator with knowledge of the local situation can facilitate contacts between GP practices and sports providers.

The availability of allied health care in nursing homes.

PURPOSE: To determine the availability of allied health care in nursing homes in the Netherlands, and its dependency on characteristics of the nursing home. METHODS: Structured surveys by telephone were carried out in a sample of 100 from a country total of 286 somatic (for somatic patients only) and combined (with units for both somatic and psychogeriatric patients) nursing homes. Multiple linear regression analyses were performed to determine relationships between the availability of care and the type of nursing home, its country location (urban/non-urban) and the presence of specific wards/units within the nursing home. RESULTS: Physiotherapy and occupational therapy were present in almost all nursing homes (99% and 93% respectively); 92% of the nursing homes offered speech- and language therapy and 88% had dietetics available. Average availability rates were: 2.16 full time equivalents per 100 beds/places for physiotherapy, 0.96 for occupational therapy, 0.38 for speech- and language therapy and 0.18 for dietetics. Somatic nursing homes and nursing homes with stroke-units, day-care, or outpatient care present, had higher availability rates on allied health care. CONCLUSIONS: Allied health care disciplines varied in terms of full-time equivalents per 100 beds/places. Per discipline also a wide variation exists in full-time equivalents per 100 beds/places among all participating nursing homes, regardless of their type. Characteristics of nursing homes had small effects on availability rates. International research is recommended in order to compare data and eventually reach consensus on optimal availability rates of allied health care in nursing homes, tuned to the demand.